Malocclusion is a common condition as is treatment. One potential benefit of orthodontic treatment is an impact on quality of life (QOL) and increasingly these measure are being used to assess both the impact of treatment and the effect of malocclusions on QOL.

The main aim of this review was to assess the impact of malocclusion on oral health related quality of life (OHRQOL)

Methods

Searches were conducted in the Medline, Embase, Web of Science, Cochrane CENTRAL, PsychInfo, CINHAL and Scopus databases as well as Google Scholar. English-language studies providing quantitative information about the association of malocclusions with OHRQOL assessed by a questionnaire validated for the use in children were considered. Two reviewers carried out data extraction independently. Methodological quality was assessed using the Newcastle-Ottawa Scale (NOS) adapted for cross-sectional studies.

Data for boys and girls was combined if presented separately. Studies that used a continuous OHRQOL scale (mean ± SD) were grouped in one meta-analysis. Studies that used a categorical OHRQOL outcome (no impact vs impact) were grouped into another meta-analysis. Some studies were included in both analyses. Subgroup analyses of both meta-analyses were conducted to assess heterogeneity among the studies.

Results

40 cross-sectional studies were included in the meta-analyses.

A range of OHRQOL measures were used

Measure

No of Studies

Child Perceptions Questionnaires, (CPQs) 8–10 years

4

Child Perceptions Questionnaires, (CPQs) 11–14 years

14

Child Oral Impact of Daily Performances (OIDP)

9

Child Oral Health Impact Profile (COHIP)

2

Early Childhood Oral Health Impact Scale (ECOHIS)

5

Oral Aesthetic Subjective Impact Scale (OASIS)

1

Oral Health Impact Profile (OHIP)

5

Psychosocial Impact of Dental Aesthetics Questionnaire (PIDAQ)

2

Summary measures of the continuous data show that OHRQOL was significantly lowered in children with malocclusions (standardized mean difference (95 % CI] = 0.29 (0.19-0.38)).

Children with malocclusion are more likely to have an impact on OHRQOL than children without malocclusions Odds ratio = 1.74(95%CI; 1.46-2.08)

High heterogeneity was seen in both analyses.

Heterogeneity among studies was partly explained by malocclusion assessment, age of the children and country of study conduction.

Conclusions

The authors concluded:

The association of malocclusion and OHRQOL has mainly been assessed in cross-sectional studies. From these studies, it can be concluded that children perceive a small impact of malocclusions on OHRQOL. The effect of malocclusions on OHRQOL is modified by the age of the children and their cultural environment. Further research should investigate whether remaining heterogeneity in the association of malocclusions with OHRQOL can be explained by other individual factors of the children.

Comments

There have been a number of systematic review on this topic two of which we have covered in previous blogs (Dental Elf – 22nd Sep 2014 & 12th Jun 2014). All these reviews tend to show that malocclusion has an effect on quality of life although this seems to be small. All of the studies included in this new review are cross-sectional so may not represent changes in life circumstances or impact of orthodontic treatment. The authors also highlight that they took the decision to include all the studies and not differentiate based on quality. They also did not take into consideration whether the questionnaire were completed by parents or children.

Derek Richards is the Director of the Centre for Evidence-based Dentistry, Editor of the Evidence-based Dentistry Journal, Consultant in Dental Public Health with Forth Valley Health Board and Honorary Senior Lecturer at Dundee & Glasgow Dental Schools. He helped to establish both the Centre for Evidence-based Dentistry and the Evidence-based Dentistry Journal. He has been involved with teaching EBD and a wide range of evidence-based initiatives both nationally and internationally since 1994.